BACKGROUND: Canada is the only country with a fully implemented labeling policy that includes efficacy messages about cessation tips and benefits inside cigarette packs. In 2024, messages were updated and responses to them remain unassessed.
METHODS: We analyzed data from an open-cohort of Canadian adults who smoke, surveyed every 3 months from February 2023 to November 2024 (n=12022 observations, 4716 individuals). At each survey wave, participants reported the frequency of reading health messages inside packs in the past 30 days (0=never/rarely; 1=sometimes/very often); how much the messages made them feel they would benefit from quitting (1=Not at all-5=Extremely); confidence/self-efficacy to quit smoking (1-“not at all”–5-“extremely”); and forgoing cigarettes due to these messages in the prior 30 days (1=yes vs. 0=no). Before answering these questions, participants viewed a brief video to focus their attention on messages inside packs. Linear and logistic generalized estimating equation models regressed these outcomes on implementation period (pre-policy 2023=[ref] vs post-policy 2024 surveys). Mixed-effects logistic models analyzed quit attempts during a 3-month interval for participants with at least one follow-up (6959 observations, 2356 individuals), using message responses from the previous survey as predictors. All models adjusted for sociodemographics, smoking-related variables, and post-stratification weights.
RESULTS: In adjusted models, reading the messages (AOR=1.18; p=0.010), perceived benefits of quitting (β=0.07; p=0.020), self-efficacy to quit (β=0.08; p<0.01), and forgoing cigarettes (AOR=1.14; p=0.039) increased from pre-to post-policy. The likelihood of attempting to quit by follow-up was higher for participants who read messages more frequently (AOR=1.54; p<0.001), perceived greater benefits of quitting (AOR=1.31; p<0.001), had greater self-efficacy to quit (AOR=1.32; p<0.001), and forwent cigarettes (AOR=1.88; p<0.001).
CONCLUSIONS: After Canada implemented new efficacy messages inside packs, reading messages, perceived cessation benefits, self-efficacy to quit, and forgoing cigarettes increased, suggesting these messages successfully re-engaged smokers. Other countries should consider complementing pictorial warnings with efficacy messages.